What’s depression got to do with the happy event of giving birth? Plenty!

Postpartum depression (PPD) is a fairly common phenomenon, affecting about 10-20% of new mothers. One recent study found that approximately one in seven women sought professional help for depression symptoms during pregnancy or the first year after giving birth.

Identifying and treating PPD is important because maternal depression affects every member of the family—not just Mom. Of course, the mother experiences both mental and physical consequences with depression, but a depressed mother tends to be less responsive to her baby and any older child. Mothers who are depressed are less likely to breastfeed or are more likely to stop earlier. Depressed women report poorer communication with their partners, so the marital relationship often suffers. When untreated, the impact of maternal depression may linger and continue to affect family members for decades.

Identifying PPD is the first step. A new mother experiencing depression is likely to report that she feels as if she’s walking around in a constant fog, and she’s likely to report that for much of each day she experiences several of the following:

• Difficulty thinking clearly or concentrating.
• Lack of enjoyment or pleasure in her baby or from activities that usually engender such feelings for her.
• Intense feelings of sadness, hopelessness, helplessness and/or failure.
• Feelings of exhaustion or lack of energy, often in combination with insomnia—difficulty sleeping– even when her baby is sleeping.
• Poor appetite. (Some mothers report overeating.)
• Going through the motions of caring for her baby while also feeling a sense of detachment from the baby.
• Repeated, intrusive thoughts about harming the baby—or feeling overanxious about the baby. Either may be associated with frequent calls to the baby’s healthcare provider.
• Suicidal thoughts—she may think her baby and others would be better off without her.

There are several assessment tools that may be used by health care providers to screen for PPD. One of the most widely used is the Edinburgh Postnatal Depression Scale (EPDS), because it is a simple and reliable questionnaire for determining whether a woman needs further assessment or treatment. Plus, it’s available in several languages.

Once identified a variety of treatments may be useful for postpartum depression. Certainly, psychotherapy and antidepressant or anti-anxiety medications are often recommended and relieve symptoms for many women. Dietary measures may help, because small proteins called cytokines, a part of the body’s inflammatory response, may contribute to depression, and these proinflammatory cytokines are at higher levels during the last trimester of pregnancy. Increasing dietary omega-6 fatty acids, such as those in vegetable oils, and omega-3 fatty acids, such as those in fish oils, can lower these proinflammatory proteins. In addition, research has found that regular exercise, such as brisk walking (while pushing a strolling or carrying baby in a sling), at least two or three times a week reduces depressive symptoms.

Although not typically thought of as a treatment for PPD, research has shown that breastfeeding actually lowers maternal stress. Other studies have found that mothers who continued to breastfeed during PPD remained more responsive to their babies. With few exceptions, breastfeeding can continue during treatment for PPD. Many anti-depressant or anti-anxiety medications are considered compatible with breastfeeding. Healthcare providers should be made aware that a mother is breastfeeding so, if medication is needed, an appropriate medication may be prescribed.

A number of resources exist for women with PPD, their families and the healthcare providers treating them. Postpartum Support International (PSI) lists links for families and health professionals and offers local or area contacts. Health professionals caring for breastfeeding women would benefit from A Breastfeeding-Friendly Approach to Depression in New Mothers from the New Hampshire Breastfeeding Task Force.

As a PSI poster poignantly notes, PPD is the number one complication of childbirth. Its impact is so profound that HR20—the Melanie Blocker-Stokes Postpartum Depression Research and Care Act, has been introduced in the U.S. House of Representatives for funding to study PPD causes and treatment. And it seems fitting that Depression Awareness month comes to a conclusion with PSI’s October 24^th Blog for the Mothers Act to promote the passage of U. S. SB1375 that proposes to provide pregnant women and new mothers with PPD education, screening, and research and treatment options. It’s time that every month is a depression awareness month—and every day is a depression screening day…